目的:成人早发性糖尿病(年龄<40岁)的并发症风险增加,目前尚不清楚他们是否正在接受指南推荐的护理。我们比较了早发性和常发性糖尿病成年人的血红蛋白A1c(HbA1c)检测频率和结果,并评估了与指南一致性相关的因素。
方法:来自艾伯塔省的人口级数据库,加拿大(约450万)被用来识别患有糖尿病的成年人。该队列在诊断时按年龄分层(<40vs.≥40年),然后随访365天进行HbA1c测试。调整后的多变量分析用于确定与指南一致性相关的临床和社会人口统计学因素。
结果:在23,643名成年糖尿病患者中(平均年龄54.1±15.4岁;女性占42.1%),18.9%患有早发性糖尿病。早发性糖尿病与较低的测试频率相关(调整后比值比(aOR),0.80;95%CI0.70-0.90)及以上目标血糖水平与正常发作糖尿病(aOR,1.45;95%CI1.29-1.64)。与指南一致的HbA1c检测频率相关的因素是农村居住和胰岛素使用。
结论:在我们提供免费医疗服务的全民医疗环境中,与正常发病的糖尿病患者相比,早发性糖尿病患者的HbA1c检测率较低,血糖控制处于次优状态.
OBJECTIVE: Adults with early-onset diabetes (age < 40 years) have an increased risk of complications, and it is unclear whether they are receiving
guideline recommended care. We compared the frequency and results of haemoglobin A1c (HbA1c) testing in adults with early-onset and usual-onset diabetes and assessed factors related to
guideline concordance.
METHODS: Population-level databases from Alberta, Canada (∼4.5 million) were used to identify adults with incident diabetes. The cohort was stratified by age at diagnosis (< 40 vs. ≥ 40 years) and then followed for 365 days for HbA1c testing. Adjusted multivariable analyses were used to identify clinical and sociodemographic factors associated with
guideline concordance.
RESULTS: Among 23,643 adults with incident diabetes (mean age 54.1 ± 15.4 years; 42.1 % female), 18.9 % had early-onset diabetes. Early-onset diabetes was associated with lower frequency of testing (adjusted odds ratio (aOR), 0.80; 95 % CI 0.70-0.90) and above target glycaemic levels compared to usual-onset diabetes (aOR, 1.45; 95 % CI 1.29-1.64). Factors associated with
guideline concordant frequency of HbA1c testing were rural residence and insulin use.
CONCLUSIONS: In our universal care setting with premium-free health care, early-onset diabetes was associated with lower rates of HbA1c testing and sub-optimal glycaemic control compared to those with usual-onset diabetes.